Facility Evaluation Report

Licensing Program Analyst (LPA) Nancy Guillen is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA was greeted and granted entry into the facility after explaining the purpose of the visit. Administrator (AD) Dung Ho was notified via telephone and later arrived to assist with the inspection. LPA observed Administrator certificate is current with an expiration date of January 5, 2027. This is an Adult Residential Facility licensed for six ambulatory clients. LPA observed two clients present at the facility at the time of visit and was informed that two clients were away at day program.

LPA began the tour of the inside and outside of the facility and observed the following:

This is a one story facility with four client bedrooms, one staff room, two bathrooms, a living room, kitchen, covered patio, dining room, and an attached garage used as an office and storage space. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in the garage. LPA observed knives and sharps to be stored in a locked garage cabinet. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. The facility is maintained at a comfortable temperature. LPA observed that medication is centrally stored in a locked storage cabinet located in the garage. LPA reviewed medication and observed medication was labeled and stored inaccessible to clients in care.

Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 131.9 and 132 degrees Fahrenheit; a deficiency was cited on today's date. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants were stored in a locked cabinet in the garage. The facility has an available clean supply of linens in a storage cabinet in the garage.